Incidência de sintomas gastrintestinais e efetividade do tratamento nutricional e uso de simbiótico em pacientes adultos com HIV/AIDS

Abstract

The aim of this research was to investigate the incidence of gastrointestinal symptoms (GIS), associated factors and nutrition therapy associated or not with synbiotic use effectiveness in reducing gastrointestinal symptoms in adult patients with HIV/AIDS. This study is nested in an outpatient cohort of 337 patients aged ≥ 19 years with HIV/AIDS, in use of antiretroviral therapy (ART) or not, who presented at the Universidade Federal de Goiás Hospital das Clinicas’s Infectoparasitary Diseases Clinic from october/2009 to july/2011 and is divided into two parts. The first part consisted in analysis of patients who referred for nutritional consultation (n=290). We investigated the incidence of nausea and/or vomiting, dyspepsia, heartburn, diarrhea, constipation and flatulence in the last week and the outcome variable for the analysis of associated factors was the presence of three GIS or more. An association with socioeconomic, clinical and anthropometric variables through incidence ratio (IR) with a 95% confidence interval (95%CI) and statistical significance at p <0.05 was executed. Multivariate analysis was performed using Poisson regression when p <0.20 in the bivariate analysis. The second part consisted of a randomized double blind study with patients on ART with at least one GIS (n=64), allocated into two treatment groups: nutrition therapy + placebo (NTPLA) and nutrition therapy + synbiotic (NTSYN) with 1:1 ratio. The primary outcome was the evaluation of GIS before and after intervention. We analyzed intra-group difference by McNemar's test at p <0.10 significance level by intention to treat. All patients signed a written informed consent. Among 290 patients, the incidence of three or more GIS was 28.8 % (95%CI 23.17-33.84) and 74.48 % presented at least one symptom. Female sex (IR 2.29, 95%CI 1.63-3.22) and smoking habit (IR 1.93, 95%CI 1.30-2.88) were significantly associated with GIS after multivariate analysis. NTPLA was effective in reducing heartburn and diarrhea. NTSYN reduced nausea and/ or vomiting, dyspepsia, diarrhea and constipation. There was a high incidence of GIS in people living with HIV/AIDS (PLWHA), especially among women and smokers. Both treatments have shown positive effects on reducing GIS, reinforcing the importance of nutritional therapy in PLWHA and possibility of synbiotic implementation in clinical practice for GIS control in this population.